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Behavior and mood disorders in focal brain lesions.

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BOOKS
Reviews
Neurologic Athletic Head and Spine Injuries
Edited by Robert C. Cantu
Philadelphia, WB Saunders, 2000
385 pp, illustrated, $69.00
Edited by an established leader in the field, Neurologic Athletic Head and Spine Injuries is the most recent textbook edition to the growing literature on neurological injuries in
sports.
Although a few of the chapter authors are new names on
the scene, many of the 35 authors are recognized experts in
the clinical or basic neurosciences and/or sports medicine. I
noticed that only 3 of the authors are neurologists, which
may reflect the fact that either neurology has made little in
the way of contributions to sports medicine, or that neurologists were simply not selected to write about common neurological conditions discussed in this book. For instance, the
chapter titled “Epilepsy and Athletics” was written by a resident in orthopedic surgery who is unlikely to be consulted
for the management of athletes with epilepsy. The strongest
and longest chapter is written by Christopher C. Giza and
David A. Hovda, titled “Ionic and Metabolic Consequences
of Concussion.” They do a wonderful job of making a complex subject understandable even for the reader who is a novice to neuroscience. Their description of the cascade of
chemical intracellular and extracellular events triggered by
biomechanical trauma is enlightening, clear, and concise.
The mechanism of diffuse axonal injury is explained in simple, understandable terms.
Other strong chapters include “Biomechanics of Spine Injuries” by James C. Otis and “Headache in the Athlete” by
Robert J. Dimeff. The information Dimeff provides on
headache includes a very extensive review of the literature
and offers some very specific suggestions for treatment that
most practioners will find useful. Otis reviews his own research as well as that of other investigators, providing the
clearest and most helpful series of figures, graphs, and tables
available anywhere regarding spinal injuries.
Topic areas that would have benefitted from expansion
include the biomechanics of head injury and the usefulness
of specific neuroimaging techniques in the evaluation of
traumatic brain injury in sports. The authors failed to emphasize the superiority of MRI over CT scans in the detection of parenchymal lesions associated with traumatic forces,
which can lead to shearing of small blood vessels and associated traumatic axonal injury.
The book itself is an attractive hardcover edition of 35
chapters covering 385 pages. It includes numerous helpful
illustrations. Practioners in sports medicine will find this a
handy reference text that should also be made widely available in hospital and academic libraries.
James P. Kelly, MD
Chicago, IL
Principles of Neuroepidemiology
By Tracy Batchelor and Merit E. Cudkowicz
Woburn, MA, Butterworth-Heinemann, 2001
374 pp, $95.00
Given the growth of knowledge on the epidemiology of neurological disorders, and the want of a textbook specifically
devoted to the fundamentals of this burgeoning field, Principles of Neuroepidemiology is a much-needed addition to the
field. As noted by the authors in the initial pages of this
book, several features of neurological disorders present
unique problems to epidemiological investigation, and these
issues are not addressed in general textbooks of epidemiology
or in general textbooks of neurology. The current textbook
includes 16 chapters. The initial four chapters provide a review of elementary principles. In Chapter 1, the author discusses the basic measures of disease frequency and association, study design, and the issues of bias, confounding, and
effect modification. In Chapter 2, the authors skillfully
present the essential statistical methods used in analysis of
data. The third chapter is devoted to a discussion of the design of clinical trials. It is written in a clear manner and
details many of the basic issues (eg, choice of primary endpoints, selection of the patient population) that are central to
the design of methodologically rigorous studies. Chapter 4
deals with the important issues of measurement and scale
development for clinical studies, and is followed by a useful
index of health measurement scales. Each of these initial
chapters is concise, and written with a refreshing degree of
clarity, covering the topics of interest in a detailed yet focused manner.
The ensuing 12 chapters are devoted to particular diseases
(eg, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis), groups of diseases (eg, brain tumors, neurogenetic disorders), or common complaints (eg, backache). The structure
of these chapters tends to be similar, first dealing with issues
of definition and diagnosis, then descriptive epidemiology
(eg, incidence, prevalence, mortality), analytical epidemiology (eg, risk factors), interventional studies, and conclusions.
This organization facilitates cross-referencing and comparison of information in the different chapters. It is difficult to
exhaustively cover all of the neurological disorders in one
volume, and as the authors have noted, they focused on
those that affect adults and that are predominantly present in
the United States. Aside from essential tremor, most of the
common neurological diseases have been covered. The chapter on Alzheimer’s disease includes tables on incidence and
prevalence rates according to age range. Their layout allows
the reader to absorb the information easily. In the chapter on
stroke, the authors do an excellent job of summarizing the
results of the many interventional studies, using several tables
to summarize information. This textbook is an important addition to the ever-growing field of neuroepidemiology, and it
fills an obvious void. The book pulls together practical information from a wide variety of sources and would be of
value for students of neurology, epidemiology, and public
health, and clinicians involved in both observational and interventional epidemiological studies (ie, clinical trials).
Elan D. Louis, MD, MS
New York, NY
© 2001 Wiley-Liss, Inc.
425
Vascular Dementia
Edited by J. S. Meyer, G. M. Rauch, H. Lechner, C. Loeb,
and J. F. Toole (Honorary Editor)
Armon, NY, Futura, 2000
320 pp, illustrated $88.00
Early in the twentieth century, following the contributions of
Binswanger, Alzheimer, Pierre Marie, and Kraepelin, atherosclerotic dementia was considered the most common form of
senile dementia (followed by syphilitic dementia, also called
dementia paralytica or general paralysis of the insane, a common cause of dementia and stroke in pre-penicillin days). In
the 1970s, Alzheimer’s disease was recognized as the leading
cause of cognitive deterioration in the elderly. During the
subsequent 30 years, the pendulum of research interest has
moved away from vascular forms of cognitive deterioration.
The advent of brain imaging demonstrated the importance
of multiinfarct dementia, strategic single strokes, lacunae,
and ischemic periventricular leukoencephalopathy as vascular
causes of dementia. In the last decade, the pendulum has
swung back and international research on vascular dementia
(the second most frequent, potentially preventable, and to
some extent treatable form of dementia) has greatly increased
as a result of efforts to define and provide diagnostic criteria
for this condition and the unexpected and frequent association of cerebrovascular lesions in patients with Alzheimer’s
disease.
This surge of research interest in the field of vascular dementia has been reflected in the publication of three recent
books on this topic, two from Europe (Vascular Dementia,
edited by D. Leys and Ph. Scheltens, 1994, and Cerebrovascular Disease and Dementia: Pathology, Neuropsychiatry and
Management, edited by E. Chiu, L. Gustafson, D. Ames, and
M.F. Folstein, 2000) and the most recent one, a joint effort
from the United States and Europe, reviewed here. The latter
is an updated version of Vascular and Multi-infarct Dementia
(1988) produced under the direction of Drs John Stirling
Meyer and Gaiane M. Rauch (Houston, TX) with contributions from Drs Helmut Lechner (Graz, Austria), Carlo Loeb
(Genoa, Italy), Alberto Portera-Sánchez (Madrid, Spain), and
others.
As mentioned by the editors, the book presents a fresh
approach to vascular dementia rather than an update of the
12-year-old first edition. Vascular dementia is defined as
“those clinical syndromes with acquired intellectual impairment resulting from cerebral damage due to cerebrovascular
disease,” and the editors present in detail newer concepts of
epidemiology, etiology, risk factors, neuropathology, and the
pathogenesis of vascular dementia. The large variety of vascular lesions and mechanisms capable of producing dementia
are discussed, including ischemic lesions, borderzone infarcts
and the now accepted role of chronic ischemia without overt
infarction (or so-called leukoaraiosis), as well as hemorrhagic
lesions, inflammatory etiologies, and microvascular involvement. Unfortunately, the overall quality of the pathology
and radiology illustrations is poor. The references are comprehensive, but very few go beyond the years 1999 and
2000.
The clinical forms of vascular dementia are classified into
eight subtypes ranging from multi-infarct dementia, strategic
strokes, lacunar dementia, and Binswanger’s disease to the
426
Annals of Neurology
Vol 50
No 3
September 2001
recently described cerebral autosomal dominant arteriopathy
with subcortical infarcts and leukoencephalopathy (CADASIL) linked to the notch gene on chromosome 19. However,
CADASIL, arguably the most important discovery in vascular dementia in the last decade, is summarily discussed in a
single page among other microvascular causes of dementia.
CADASIL could have filled easily a separate chapter of this
book.
An excellent chapter discusses the no-man’s-land of Alzheimer’s disease with cerebrovascular lesions, a controversial
area for controlled clinical trials. Another valuable contribution is the presentation of the Houston Veterans Administration Medical Center cohort, followed over a mean period
of 4.3 (⫾3.1) years with annual clinical, computed tomographic, and neuropsychological tests, as well as xenonenhanced cerebral blood flow. In this study, each patient
served as his or her own control. The cohort included 218
cognitively and neurologically normal subjects with a mean
age of 58.3 years at recruitment (range 22– 89 years). A notable result of the follow-up studies was loss of perfusion of
cortical areas and white matter tissue after age 60 in association with hypertension, smoking, transient ischemic attacks,
and hyperlipidemia. Finally, the public health problems to be
faced in future efforts to implement preventive measures for
vascular dementia can be learned from the results of the Austrian Styrian cohort, where compliance in the control of hypertension, coronary artery disease, diabetes, and hyperlipidemia was “disappointingly low.”
In summary, this book presents a comprehensive and current overview of vascular dementia by experienced researchers in the field and can be highly recommended. Vascular
Dementia should be of interest to gerontologists; psychiatrists; stroke and dementia specialists; neurology residents;
practicing neurologists; specialists in cardiology, psychology,
neuroradiology, and neuropathology; as well as professionals
interested in clinical trials and public health interventions in
this growing field.
Gustavo C. Román, MD
San Antonio, TX
Behavior and Mood Disorders in Focal Brain Lesions
Edited by Julien Bogousslavsky and Jeffrey L. Cummings
New York, Cambridge University Press, 2001
554 pp, illustrated, $80.00
Many of the most exciting advances in our understanding of
diseases of the human central nervous system relate to important new insights about disorders of mood, cognition,
and behavior. Current investigations into these disorders often utilize techniques developed by persons whose orientation represents a confluence of the thinking which once was
segregated into the separate fields of behavioral neurology
and organic psychiatry. They now make use of an impressive
array of new tools, including static and functional magnetic
resonance imaging, positron emission tomography, singlepositron emission computerized tomography, and sophisticated genetic probes, as well as improved consensus diagnostic criteria and refined, validated rating scales.
This volume is a substantial compilation of investigations
into the emotional, mood, and behavioral sequelae of focal
lesions in the human brain. The editors draw upon the skills
of an authoritative panel of international contributors. Each
presents a chapter devoted to a topic of importance which
summarizes the current understanding and identifies the literature upon which conclusions are based. Typically, chapter
content deals primarily with methodology, clinical pharmacology, and the relationships between structure and function.
Usually, a chapter presents a concise overview of clinically
relevant information and a summary of the pathophysiology
and perhaps therapeutics. Each chapter concludes with an
extensive bibliography, largely of English-language publications, most published through 1996. The references thereby
provide a useful base upon which to establish a more current
search of these rapidly expanding fields using electronic vehicles such as Ovid or other similar on-line methods.
Information is organized by both anatomic localization
and clinical manifestation. True to its title, this work emphasizes focal disorders. Most chapters specify the place(s) where
disease leads to clinical dysfunction and identify the systems
or circuits which are in disarray, supported by references. Although tabulation of regional lesions is the volume’s framework, there are also sections devoted to nonfocal brain disorders, such as mania, violent behavior, schizophrenia, etc.
The majority of the photographs are clear. The figures are
well drawn and appropriate to the text. There are many tables to help concentrate information when conclusions are
based on observations from many sources.
This is a valuable book. Drs Bogousslavsky and Cummings provide a helpful resource to all persons seeking to
become better informed about the myriad conditions which
simultaneously are aspects of both the mind and the brain.
James Q. Miller, MD
Charlottesville, VA
Varicella-Zoster Virus: Virology and Clinical
Management
Edited by Ann Arvin and Anne Gershon
New York, Cambridge University Press, 2000
531 pp, illustrated, $120.00
Varicella-Zoster Virus: Virology and Clinical Management is a
multiauthored text that is both exhaustive in depth and easily comprehensible. The editors and chapter authors are internationally recognized contributors to the field of neurovirology, and despite the enormous amount of information in
this book, each chapter is concise and well organized. The
book is divided into five parts: history, molecular biology
and pathogenesis, epidemiology and clinical manifestations,
laboratory diagnosis, and treatment and prevention. There is
refreshingly little overlap between the chapters. Weller’s historical perspective is fascinating and personal. The drawings
of microanatomy that he inherited from Tyzzer remind the
reader of the power of a microscope when used by an observant clinician. The chapters on molecular biology succinctly
synthesize the contributions of many labs and researchers.
Although both herpes simplex virus (HSV) and varicellazoster virus (VZV) establish latency with neurons, probably
as a circular episome, HSV reactivates frequently and requires direct contact for spread, while VZV reactivates infrequently and during varicella can be spread by aerosols. The
chapter on VZV and pregnancy summarizes the somewhat
discordant case reports of congenital defects secondary to
VZV infection. High-level fetal ultrasound at 19 to 23 or 24
weeks is recommended for fetuses exposed to maternal VZV
infection prior to 21 weeks’ gestation; however, more subtle
cerebral abnormalities may not be detected until later in
pregnancy. The chapter on laboratory diagnosis is an excellent summary of available assays and interpretation of the
results. Immune status determination is addressed along with
the recommendation to use the history rather than antibody
status to determine management of the exposed immunocompromised patient due to the poor correlation of VZV
antibody status with clinical protection. I found the coverage
of the VZV vaccine to be one of the most interesting parts of
the book. It addresses not only current recommendations but
also their implications in terms of alterations in immunity in
the absence of life-long exposure to VZV and the future. It is
hypothesized that immunization with live VZV may protect
against zoster by achieving latency with an attenuated rather
than a fully virulent VZV and by boosting cellular immunity
against VZV. Cell-mediated immune response is attenuated
in adults compared to children, resulting in decreased efficacy of the vaccine in adults.
In the preface, the editors state that their book is “the
most authoritative review and guide to the virus and its diseases.” I agree; this book is a fascinating and eloquent text
that will appeal to neurologists, child neurologists, pediatricians, infectious disease specialists, and geriatricians.
Catherine Amlie-Lefond, MD
Spokane, WA
Annals of Neurology
Vol 50
No 3
September 2001
427
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